改良腰硬联合麻醉在产科与妇科手术中的对比研究

目的探讨改良腰硬联合麻醉技术(CSEA)的安全性、有效性和可行性,并比较在产科与妇科手术中麻醉的特点。方法选择ASAⅠ~Ⅱ级剖宫产和子宫全切手术各40例。以一次性硬膜外麻醉包和20-22G直接静脉留置针芯为材料,行两点法穿刺,在蛛网膜下腔注入1%丁卡因1m l 3%麻黄碱1m l 10%葡萄糖1m l混合液2 m l。观察起效时间、最高阻滞平面、血流动力学的变化和不良反应。结果所有患者穿刺均一次成功,效果满意,无麻醉并发症。其中剖宫产组恶心呕吐发生率、腰麻注药后平面上升的速度和最高阻滞平面均大于子宫全切组,两组患者在注药后10~30m in血压和心率下降,剖宫产组30m in后血压下降最明显。结论以该法行CSEA,简便易行,价格低廉,麻醉效果满意。可安全用于产科和妇科等手术的麻醉,但在剖宫产手术中宜尽早将阻滞平面控制在较低范围。

A comparative study of combined spinal - epidural anesthesia for obstetric and gynecological operations

Objective To investigate the safety,efficacy and feasibility of modified combined spinalepidural anesthesia(CSEA),and compare the anaesthetic effect during the obstetric and gynecological operations.Methods Forty cases of total hysterectomy and 40 cases of ASA1~2 C-sect were anesthetized with modified CSEA,with the help of EA-pack and 20-22G veno-detained injection-needle,two-point puncturation,2ml mixed liquor of 1% dicaine(1ml) and 3% ephedra alkali(1ml) and 10%GLU(1ml) was injected in cavum subarachnoideale,to observe the super-effect time,max-block plane,the change of hemodynamics and adverse effects.Results All cases were punctured successfully once,no complication of anesthesia happened,the incidence rate of nausea-vomitus and the ascendent speed of LA plane,and max-block plane of group C-sect was more than group womb-holotomy,the BP and HR of all cases descend after medication 10~30min,the BP of group C-sect descend obviously 30 min later.Conclusion The modified CSEA has the characteristics of simple-performance,less cost,satisfacted effect.It can be adopted safely during the obstetric and gynecological operations.However,the block-plane should be controlled to low-plane as early as possible during C-sect.